Caninsulin
[http://www.caninsulin.com/Pharmacokinetics-of-Caninsulin-veterinary-insulin.asp Caninsulin], manufactured by Intervet and known in some countries as Vetsulin, is a veterinary porcine lente insulin, made up of 30% semilente (short-acting) and 70% ultralente (long acting) insulins. At present in the US, Caninsulin is FDA-approved for use only in dogs under the trade name Vetsulin. However, it is often used in the US for cats. How it works in cats Caninsulin is intended for dogs, but works (somewhat differently) in cats too. It has an interesting mechanism, which even though it is mostly long acting insulin, generally has an early peak in cats. My cat Butterscotch peaked anywhere between 3 and 4 hours, but from the peak, it took quite a while for his blood glucose to start the rise back up, generally after 6 hours. The graph below shows how the insulin is metabolized in most cats, and when it has been completely drawn in to the system. As you can see, the effect starts almost immediately, bringing levels down, and after two hours it steepens to peak drop at approx 4 hours. Then there is a nice flatter period of about 2 hours, after which the levels curve back up. REMEMBER THE BLUE HARD DROP IS OF INSULIN NOT OF BLOOD GLUCOSE. The glucose drops much less harshly. I found that after about 2 days on a dose, the curve up was much flatter and I had short ended curves. For example, if my cat had a blood glucose level of 30 mmol/L (540 mg/dL), before his morning shot, 12 hours later he would be about 23-25 mmol/L (414-450 mg/dL) before his evening shot. As he responded, his next preshot blood glucose level would go from 25 mmol/L (450 mg/dL) to 15 mmol/L (270 mg/dL), and so on. Image:http://www.caninsulin.com/images/insulinactivitycat.jpg Caninsulin is a BID (two times a day) insulin in cats. Personal notes and interpretations 1. Caninsulin gives good remission results, if you monitor closely. My cat Butterscotch has been insulin free for 1 month, and had a number of "mini honeymoons" before that of 2 or 3 days. (Of course this cat may have been a transient diabetic to begin with and might have responded well to any insulin.) In hindsight and looking at weight loss and the dramatic decrease in litter since regulation, vets are convinced he was diabetic for at least 2 years, since I got him. 2. Because of the last two hours with no insulin left in the body, if necessary and on consultation with your vet, it is possible to give a dose a little early if glucose levels are sky high. When Butterscotch hit 31 mmol/L (558 mg/dL) after 1 unit, at +10 , I called the emergency vet, and was told not to wait, to give 2 units immediately and to monitor closely (with home tests). 3. Caninsulin gets a good response, once the "glass floor" allowing lower levels (possibly due to glucose toxicity) is broken. But this may not be possible with every cat. 4. Because of Caninsulin's good response, home testing is very important. You may well find that after a few days on a dose, curves become L shaped, and make it necessary to reduce the dose. Hypoglycemia is a concern, if you dose blindly and aren't prepared to lower doses as needed. However, lower doses mean the cat is responding to the insulin. 5. You may also find that a cat that has not responded initially will shock you with the next increase of dose, and a strong positive response. Dont panic. Then you will be starting a dance of dosing on based on preshot blood glucose readings and hopefully end with remission. Or, you at least have a cat that can be controlled for a number of hours a day 5. Skipping a dose of Caninsulin due to low blood glucuse levels does not seem to result in a much higher level the next preshot. The next blood glucose level is generally around the same or lower than the last one you dosed at. 6. With Caninsulin, it is very easy to adjust dose times if needed. Because of its 70% long-acting portion, and its 2 hour window of no insulin in the body after 10 hours, when you have to miss a dose, or change the time to later due to an appointment, don't panic but DO monitor. Changing shot times is not recommended but life does happen. 6. Caninsulin is a scary insulin if you don't examine its mechanism and do curves. Once you get a grip on what your cat is doing, you will find it a terrific help in regulation. 7. Dont assume the early drop is too fast. This is due to the 30% intermediate portion, and kick-starts the body, after which the long lasting takes over. 8. Caninsulin is a gentle insulin, so long as you remember its doesn't work like others. Cats tolerate it very well. Caregivers of those cats tolerate it less well. Just breathe and look at your curves and levels. 9. One note from the Caninsulin web site. Somogyi and its associated insulin-sensitivity changes can continue for a few days after a hypoglycemic episode, so do NOT shoot unless you are certain that it's not happening by looking at your curves. 10. Caninsulin is great insulin that gives good results in many cats. Home testing is in my opinion even more important with this insulin due to its good responses. How it works in dogs The majority of dogs on Caninsulin/Vetsulin (two-thirds) also will require twice daily injections. Caninsulin/Vetsulin is a lente insulin, which is classed as intermediate, not long acting. Long acting insulins (such as Ultralente and PZI) have a poor success rate among dogs. For those with dogs, here is a graph of the canine activity. Image:http://www.caninsulin.com/images/insulinactivitydog.jpg Technical details Caninsulin is an aqueous suspension of insulin containing 40 IU per ml of highly purified porcine insulin, 30% is amorphous zinc insulin and 70% crystalline zinc insulin. The difference between Caninsulin and both Iletin II Lente made by Eli Lilly and Monotard Pork made by Novo Nordisk is this: Caninsulin/Vetsulin is a veterinary insulin of U40 strength. Both Novo's and Lilly's insulins were U100 strength. Caninsulin contains porcine insulin. Porcine insulin is identical to canine insulin, but differs from feline insulin in respect of one key amino acid. How to get it It is a prescribed insulin, for veterinary use. A human pharmacy will not have it, and you must get a prescription. It is available online in some countries, and may cost less that way. Available in 2.5ml and 10 ml vials. Cats and and small dogs can get new vials monthly without wasting. Because Caninulin is is a U40 insulin, U40 syringes are the most helpful. If you choose to use a U100 syringe, you must do the U-40 to U-100 conversion. The conversion is not difficult and can give you precision of 0.2 units for those animals needing a more precise dose. Special Syringes: Good or bad? Personal note: I used a human U100 syringe when I ran out of the Caninsulin syringes and my cat Butterscotch stared at me in shock with wide eyes! The Caninsulin syringes are not only thin but seem to be made in such a way that pets don't notice it--one person's experience with one cat: probably not really a "most cats" thing at all. In general you will find that "most cats" are amazingly tolerant of any shot or needle, whereas mine did notice the U100 syringe. No idea why, perhaps the slope...The Caninsulin U40 syringe is very small. Another user's personal note: My little Max (all whopping 7 pds of world-traveling, "he-man" poodle-extraordinare) is usually not adverse to needles (he handles the fructosomine and BG curves at the Vet with flying colors, nary a peep out of him). But, when it came to using the U-40 syringe, whether administered by the Vet or myself, it was a complete 180-degree reversal. After speaking at length with Vets treating Max, we felt the best approach was to switch to the BD Ultra 100 syringe with the 31 gauge needle. Granted, you have to do the math, a x2.5 conversion of dosage for the U-40 to U-100 switch, but I can tell you if you have a problematic pet when it comes to using the U-40, the extra money these syringes cost is well worth the lessening of aggravation to both owner and pet. Picture of the caninsulin syringe: http://thomasmesereau.squarespace.com/storage/animals%20083.jpg External Links * Caninsulin web site * Vetsulin web site * Buy vetsulin online, perhaps cheaper than at your vet *PetPharm offers Caninsulin as an over the counter (OTC) medication. Their policy is to ship insulin within Canada only with deliveries made by courier. *Best Pet Pharmacy is online and UK-based, serving the UK and Northern Ireland only. As of October 31, 2005, UK law abolished all charges vets could make for writing prescriptions so one could possibly obtain medications cheaper elsewhere. All insulins in the UK are considered POM--prescription-only medications. Abolition of the fees for writing prescriptions makes it possible to obtain one and then shop with them online. *Horn-Mitten study from Australian Veterinary Journal, citing Church's study equating Caninsulin with Monotard Pork, thus the need for two shots a day in dogs. *Use in rabbits Though not licensed/approved for use in rabbits, Intervet presents some helpful information on using Caninsulin/Vetsulin for them. Category:InsulinsCategory:intermediate-actingCategory:Lente Category:VeterinaryCategory:porcine